Colorado Associated Community Health Information Exchange

1. Creating a Shared Quality Improvement Reporting System Colorado Associated Community Health Information Exchange Lisa Schilling, MD, MSPH AHRQ Annual Conference Sept. 8, 2008

2. CACHIEParticipants • 14 Colorado federally qualified community health centers • Colorado Community Managed Care Network • Colorado Community Health Network • Others

3. Presentation Objectives • Illustrate the use of business process analysis to inform user requirements

4. CACHIE Goals • To promote the use of information technology to support quality reporting and improvement across the CHC networks • To design, build, & implement a shared system for quality reporting among 6 CHCs with 4 disparate EMR/PMS • To assist CHC with EMR template implementation to improve care provision, documentation & measurement.

5. Data <---> Information Provide Care Template Document Care Measure Care

6. What is a business process? Business process: A “business process” describes a set of activities and tasks that logically group together to accomplish a goal or produce something of value for the benefit of the organization, stakeholder, or customer. Dictionary

7. Why Use Business Process Analysis? • Everything is not as it appears to be: • Unintended internal and external consequences • It’s not just a “flip of the switch” • Technology must complement workflow • Expectancy: • Exceeding capacities • Fashion: • Unnecessary complexity • Remaining current • Stakeholder interest: • Varying levels over time • Developing consensus

8. Method Business Process Analysis Business Process Redesign Requirements Definition • THINK • How do we do our work now? • Define goals and objectives • Model context of work • Identify business rules • Describe tasks and workflows • Identify common task sets • RETHINK • How should we do our work? • Examine tasks and workflows • Identify inefficiencies • Identify efficiencies with repeatable processes • Refine business processes and rules • Remodel the context of work • Restructure the tasks and workflow • DESCRIBE • How an information system can support our work? • Define tasks to be performed for optimized business processes • Describe the implementation of business rules • Describe in words and graphics how an information system is to be structured • Determine scope of next phase of activities

9. BPA Example #1 • Outcome:Provide a “fast food” customer with their order efficiently and receive payment.

10. Customer Legend Restaurant Order Fulfillment Process Context Diagram Transaction Outcome Burger Station Food inventory Output Supplies (wrappers) Input Burger Order Burger Greeting Order taker Fry Station Order Detail Fry Order Amount Due Food inventory Payment Fries Supplies (oil) Change Order Drink Drink Order Drink Station Reports, receipts Beverage inventory Supplies (straws, cups)

11. CACHIE BPA Purpose • Align the Information system (IS) with the organization’s mission, • need a clear model of the desired outcomes and the business processes that result in those outcomes. • IS should support and enhance business processes. • Creating a shared system required that we understand CHC business process similarities and differences.

12. CACHIE BPA Goals • Develop a common definition of quality improvement reporting system • Describe and visually document how quality improvement efforts are accomplished • Describe how the quality improvement efforts will function with the quality IS • Develop a list of functional requirements to drive information system design and implementation

13. On The Road Sunrise Clinica Peak Vista Mountain Family High Plains Valley Wide

15. BPA Example #2 • Outcome: Improve the provision and documentation of guideline concordant care in primary care clinic.

16. Provide & Document DM Eye Care • Goal: Provide DM pts guideline concordant care • Objective: Ensure DM pts receive eye exams • Business rules: Electronic referrals are not possible, referrals to both internal and external providers. • Trigger: DM pt presents for care (other?) • Task Set: Care for any acute needs, refer for DM care • Outcome: Provide & document DM eye care

17. Legend Providing and Documenting Guideline Concordant Care Transaction Outcome Internal Ophthalmologist Output Input Referral to Retinal Exam documented Provider EMR- Codified, text, scan External Ophthalmologist Document Care Referral to Enter Eye Referral Scan Diabetic Patient Ophth note Med Records Quality Reports

18. BPA- other topics • Lab ordering & results handling, • Documentation of foot exams & self-management goals, • Incorporation of new or modified guidelines into their patient care processes, into their EMR templates, into their quality reporting, • Current methods of creating & using quality reports from EMR data, challenges and successes.

20. What We Learned • Templates • Not uniformly available, • Require costly professional support to develop/modify, • Require lots of CHC staff time, • When available, not always used, • Not automatically linked with “forms” -> double data entry, • Desire for more & improved

21. What We Learned- con’t • Quality Reporting • Great variability among CHC capacity • Requires professional support ($$) to develop reports • Reporting limited by $$$ • Reporting limited by system • Desire for data (re-)use

22. What We Learned- con’t • Quality Reporting-2 • Analyze at provider, pod, clinic site, CHC level • Analyze discrete specified time periods • Track trends for individual patients • Provide pre-built reports (UDS, etc) • Easily create reports for individual CHC needs • Save & share built reports • Run “huddle” reports based on scheduled patients

24. CACHIE Steering Committee Ross Brooks, Director Molly Brown, Manager Art Davidson, Co-Medical Director Jason Greer, HIT Director Molly O’Fallon, Clinical Quality Director Lisa Schilling, Co-Medical Director Dan Tuteur, CCMCN Ex. Director HIT Committee David Adamson, Mountain Family HC Kitty Bailey, CCHN Andrew Bienstock, Salud Family HC David Fleurquin, Pueblo Community HC Pete Gutierrez, Denver Health, Committee Chair Annette Kowal, CCHN Pete Leibig, Clinica Family Health Services Konnie Martin, Valley-Wide Health Systems, Inc. Pam McManus, Peak Vista Community HC Mitzi Moran, Sunrise Community Health Paul Olson, Peak Vista Community HC John Santistevan, Salud Family HC Pat Tellez, Metro Community Provider Network It Takes a Village… AHRQ Marybeth Farquhar

25. Contacts CACHIE Project Manager Ross Brooks ross@cchn.org CACHIE Medical Directors Lisa Schilling lisa.schilling@ucdenver.edu Arthur Davidson art.davidson@dhha.org